Radiological and Clinical Outcomes of Metaphyseal Tibial Fracture Fixation Using Intramedullary Nails with Supplementary Poller Screws: A Prospective Case Series

Abstract

Background:
The use of intramedullary nails for tibial shaft fractures has become increasingly popular and is now regarded as the standard of care. However, fixing diaphyseo-metaphyseal tibial fractures with intramedullary nails presents challenges due to the natural discrepancy between the diameters of the bone in this region and the implant. To address this issue and expand the application of intramedullary nails to this specific area of the tibia, many surgeons have adopted the use of blocking screws.
Methods:
A case series involving 20 patients with diaphyseo-metaphyseal closed tibial fractures were treated using intramedullary nails supplemented with blocking screws. The patients were monitored for final alignment, union rate, and the incidence of complications.
Results:
Union was achieved in all patients, with an average duration of 20 weeks (range: 16-24 weeks). Post-operative fracture alignment was satisfactory in all cases, although three patients exhibited minor coronal plane angulation that was deemed non-significant. The fractures maintained their post-operative alignment until union. Regarding complications related to the blocking screws, one patient (5%) developed a new fracture line at the site of blocking screw placement, which was successfully managed with delayed weight-bearing and the application of a back slab for two weeks. Other complications, unrelated to the blocking screw, occurred in one case (5%), where the patient developed a deep infection.
Conclusion:
Blocking screws can effectively and safely extend the application of mechanically superior intramedullary nails to the metaphyseal region of the tibia.